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Childs DS, Novotny PJ, Marell PS, Ruddy KJ, Loprinzi CL. Hot flash clinical trial baseline measurements: how long is needed? BMJ Support Palliat Care 2024; 13:e1110-e1116. [PMID: 35477676 DOI: 10.1136/bmjspcare-2022-003681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/06/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Classically, hot flash studies included a baseline period of 1 week or longer. The objective of this study was to compare the accuracy of a 1-day baseline diary to a traditional 1-week diary. METHODS Raw data from 5 pilot studies and 15 phase III randomised controlled trials (RCTs), all of which used a 1-week baseline period, were obtained. Descriptive statistics were used to describe day-by-day variations in hot flash frequencies and scores, during the baseline week. Additional analyses evaluated whether the conclusions from any of the individual pilot studies would have been changed if only a 1-day baseline period had been used. For the RCTs, p values were recalculated using mixed models, adjusting for the baseline value by including it as a covariate. RESULTS A total of 2573 participants were included. On average, participants had 8.5 hot flashes per day on day 1. Mean hot flash frequencies and scores on subsequent days (days 2-7) were within 6% of day 1 values. When comparing a 1-day to a 1-week baseline period, there was an absolute difference of only 0.29 hot flashes per day (SD 2.25). Reanalysis for each pilot study revealed that no individual study conclusions would have been altered by a shorter baseline. For the RCTs, a shorter baseline period changed the results of only 1 of 24 comparisons from statistically significant to not significant, or vice versa. CONCLUSIONS A 1-day hot flash diary appears to accurately reflect the true frequency and severity of baseline symptoms in appropriately sized cohorts.
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Affiliation(s)
| | - Paul J Novotny
- Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
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Reiss AB, Gulkarov S, Pinkhasov A, Sheehan KM, Srivastava A, De Leon J, Katz AE. Androgen Deprivation Therapy for Prostate Cancer: Focus on Cognitive Function and Mood. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:77. [PMID: 38256338 PMCID: PMC10819522 DOI: 10.3390/medicina60010077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/26/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024]
Abstract
Prostate cancer is the second leading cause of cancer death in men in the United States. Androgen deprivation therapy (ADT) is currently the primary treatment for metastatic prostate cancer, and some studies have shown that the use of anti-androgen drugs is related to a reduction in cognitive function, mood changes, diminished quality of life, dementia, and possibly Alzheimer's disease. ADT has potential physiological effects such as a reduction in white matter integrity and a negative impact on hypothalamic functions due to the lowering of testosterone levels or the blockade of downstream androgen receptor signaling by first- and second-generation anti-androgen drugs. A comparative analysis of prostate cancer patients undergoing ADT and Alzheimer patients identified over 30 shared genes, illustrating common ground for the mechanistic underpinning of the symptomatology. The purpose of this review was to investigate the effects of ADT on cognitive function, mood, and quality of life, as well as to analyze the relationship between ADT and Alzheimer's disease. The evaluation of prostate cancer patient cognitive ability via neurocognitive testing is described. Future studies should further explore the connection among cognitive deficits, mood disturbances, and the physiological changes that occur when hormonal balance is altered.
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Affiliation(s)
- Allison B. Reiss
- Department of Medicine and Biomedical Research Institute, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, USA; (S.G.); (K.M.S.); (A.S.); (J.D.L.)
| | - Shelly Gulkarov
- Department of Medicine and Biomedical Research Institute, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, USA; (S.G.); (K.M.S.); (A.S.); (J.D.L.)
| | - Aaron Pinkhasov
- Department of Psychiatry, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, USA;
| | - Katie M. Sheehan
- Department of Medicine and Biomedical Research Institute, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, USA; (S.G.); (K.M.S.); (A.S.); (J.D.L.)
| | - Ankita Srivastava
- Department of Medicine and Biomedical Research Institute, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, USA; (S.G.); (K.M.S.); (A.S.); (J.D.L.)
| | - Joshua De Leon
- Department of Medicine and Biomedical Research Institute, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, USA; (S.G.); (K.M.S.); (A.S.); (J.D.L.)
| | - Aaron E. Katz
- Department of Urology, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, USA;
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Luo T, Elewonibi B, Williams D. A hospital-based therapeutic food pantry study for people living with cancer in New Orleans. Support Care Cancer 2023; 31:712. [PMID: 37982868 PMCID: PMC10661716 DOI: 10.1007/s00520-023-08171-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 11/07/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION Food pantries have the potential to improve health outcomes and quality of life for individuals living with cancer. Gender has been linked to certain cancer symptoms and dietary patterns. Nevertheless, the extent of research on the utilization of food pantries among this population, particularly with regard to gender differences, remains limited. The objective of this study is to explore the demographic characteristics and gender differences in quality of life, as well as the impact of cancer on the lives of individuals who utilize food pantry services. METHODS Between February 26, 2019 and July 24, 2022, 400 people living with cancer were eligible to participate the University Medical Center New Orleans (UMC) food pantry. Participants were asked to provide demographic information and completed two health assessments related to the challenges in daily activities, nutrition, and mental health. RESULTS The study participants had a mean age of 54.1, and the majority of the participants were female. More than half of the participants did not have access to a vehicle or use public transportation to access grocery stores. People living with cancer reported several quality of life issues, with the most prevalent challenges being interference of cancer with work, lack of energy, difficulty affording food, pain, and sleep problems. Additionally, less than half of the patients reported consuming fruits and vegetables on a daily basis, and males were found to be less likely to consume them compared to females. DISCUSSION The current study sheds light on the characteristics and quality of life of individuals who utilize UMC food pantry services, as well as the impact of cancer on their lives. The findings reveal a gender disparity in fruit and vegetable consumption, with male individuals living with cancer reporting lower levels of consumption. IMPLICATIONS FOR RESEARCH AND PRACTICE Identifying and addressing food insecurity among people living with cancer are necessary. Meanwhile, partnerships with community organizations may be valuable in finding ways to assist cancer survivors in returning to work. Future studies could also focus on encouraging fruit and vegetable consumption, particularly among male individuals living with cancer.
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Affiliation(s)
- Ting Luo
- Moores Cancer Center, University of California San Diego, La Jolla, CA, 92122, USA.
| | - Bilikisu Elewonibi
- Epidemiology and Population Health, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA, 70112, USA
| | - Donna Williams
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA, 70112, USA.
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Qin Z, Zang Z, Yu J, Lv J, Li N, Zhang J, Yang M, Kwong JSW, Pang R, Wang J, Cui Z, Yu Y, Wang H, Zhu Y, Yuan Y, Li X, Wu Y, Wu J. Acupuncture versus sham acupuncture and usual care for Antiandrogen-Induced hot fLashes in prostate cancer (AVAIL): study protocol for a randomized clinical trial. BMC Complement Med Ther 2023; 23:388. [PMID: 37891531 PMCID: PMC10612187 DOI: 10.1186/s12906-023-04218-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Hot flashes are the common and debilitating symptom among prostate cancer (PCa) patients undergoing androgen deprivation therapy (ADT). Strong evidence from multiple rigorously designed studies indicated that pharmacological option such as venlafaxine provides partial relief, but the tolerability is poor when dose is not tapered. Hence, alternative therapy is needed. Previous studies reported that acupuncture may be helpful in the management of hot flashes. However, the insufficient randomized controlled trial limited the quality of evidence. METHODS Five hospitals will recruit 120 acupuncture naïve patients with moderate-to-severe hot flashes after prostate cancer received ADT in China from February 2023 to December 2024. Participants will be randomly 2:1:1 allocated to the 18 sessions of verum acupuncture at true acupuncture points plus usual care, 18 sessions of non-penetrating sham acupuncture at non-acupuncture points plus usual care, or usual care alone over 6 weeks. The primary outcome measure is the change of mean weekly hot flashes symptom severity score (HFSSS) at the end of treatment compared with baseline. EXPECTED RESULTS AND CONCLUSION We will be able to measure the effectiveness of acupuncture for patients with PCa suffering from ADT-induced hot flashes and whether acupuncture is superior to sham acupuncture and usual care. The proposed acupuncture treatment might provide an alternative option for those patients. TRIAL REGISTRATION Clinicaltrials.gov (NCT05069467).
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Affiliation(s)
- Zongshi Qin
- School of Public Health, Peking University, Beijing, China
- Peking University Clinical Research Institutes, Beijing, China
| | - Zhiwei Zang
- Department of Acupuncture, Yantai Hospital of Traditional Chinese Medicine, Yantai, China
| | - Jianyong Yu
- Department of Urology, Yantai Hospital of Traditional Chinese Medicine, Yantai, China
| | - Jianqin Lv
- Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Ning Li
- Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jialing Zhang
- School of Chinese Medicine, Hong Kong Chinese Medicine Clinical Study Centre, Hong Kong Baptist University, Hong Kong, Hong Kong SAR, China
| | - Mingxiao Yang
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Joey S W Kwong
- Department of Health Policy, Department of Clinical Epidemiology, National Center for Child Health and Development, Tokyo, Japan
| | - Ran Pang
- Department of Urology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jianfeng Wang
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
| | - Zhengyu Cui
- Department of Chinese Medicine, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Yongpei Yu
- Peking University Clinical Research Institutes, Beijing, China
| | - Haibo Wang
- Peking University Clinical Research Institutes, Beijing, China
| | - Yidan Zhu
- Peking University Clinical Research Institutes, Beijing, China
| | - Yifang Yuan
- School of Public Health, Peking University, Beijing, China
- Peking University Clinical Research Institutes, Beijing, China
| | - Xiao Li
- Department of Urology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Nanjing Medical University Affiliated Cancer Hospital, Nanjing, China.
| | - Yangfeng Wu
- Peking University Clinical Research Institutes, Beijing, China.
| | - Jiani Wu
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
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Crabb S, Morgan A, Hunter MS, Stefanopoulou E, Griffiths G, Richardson A, Fenlon D, Fleure L, Raftery J, Boxall C, Wilding S, Nuttall J, Eminton Z, Tilt E, O'Neill A, Bacon R, Martin J. A multicentre randomised controlled trial of a guided self-help cognitive behavioural therapy to MANage the impact of hot flushes and night sweats in patients with prostate CANcer undergoing androgen deprivation therapy (MANCAN2). Trials 2023; 24:450. [PMID: 37430353 PMCID: PMC10332063 DOI: 10.1186/s13063-023-07325-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/12/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Androgen deprivation therapy (ADT) is prescribed to almost half of all men diagnosed with prostate cancer. Although ADT is effective treatment, with virtually all men with advanced disease showing initial clinical response, it is associated with troublesome side effects including hot flushes and night sweats (HFNS). HFNS can be both frequent and severe and can have a significant impact on quality of life (QoL). They can occasionally be so debilitating that patients stop ADT altogether, despite the increased risk of disease relapse or death. Previous research has found that guided self-help cognitive behavioural therapy (CBT) can be effective in reducing HFNS due to ADT when delivered by a clinical psychologist. MANCAN2 aims test whether we can train the existing NHS Prostate Cancer Nurse Specialist (CNS) team to deliver guided self-help CBT and whether it is effective in reducing the impact of HFNS in men undergoing ADT. METHODS MANCAN2 is a phase III multicentre randomised controlled trial and process evaluation. Between 144 and 196 men with prostate cancer who are currently receiving ADT and are experiencing problematic HFNS will be individually randomised in a 1:1 ratio in groups of 6-8 participants to either treatment as usual (TAU) or participation in the guided self-help CBT intervention plus TAU. A process evaluation using the normalisation process theory (NPT) framework will be conducted, to understand the CNS team's experiences of delivering the intervention and to establish the key influencers to its implementation as a routine practice service. Fidelity of implementation of the intervention will be conducted by expert assessment. The cost-effectiveness of the intervention and participant adherence to the trial intervention will also be assessed. DISCUSSION MANCAN2 will advance the program of work already conducted in development of management strategies for HFNS. This research will determine whether the severity of ADT-induced HFNS in men with prostate cancer can be reduced by a guided self-help CBT intervention, delivered by the existing NHS prostate cancer CNS team, within a multicentre study. The emphasis on this existing team, if successful, should facilitate translation through to implementation in routine practice. TRIAL REGISTRATION ISRCTN reference 58720120 . Registered 13 December 2022.
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Affiliation(s)
- Simon Crabb
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alannah Morgan
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK.
| | - Myra S Hunter
- Kings College London, Institute of Psychiatry, Psychology and Neuroscience, Kings College, London, UK
| | | | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alison Richardson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- University of Southampton, Southampton, UK
| | - Deborah Fenlon
- Swansea University, Faculty of Medicine, Health and Life Sciences, Swansea University, Swansea, Wales
| | - Louisa Fleure
- Guys and St Thomas NHS Foundation Trust, St Thomas Hospital Westminster Bridge Road, London, UK
| | | | - Cherish Boxall
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Sam Wilding
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Jacqueline Nuttall
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Zina Eminton
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Emma Tilt
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Alice O'Neill
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Roger Bacon
- Prostate Cancer Support Organisation (PCaSO), Emsworth, UK
| | - Jonathan Martin
- Research Department of Primary Care and Population Health, University College London, London, UK
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Vita G, Compri B, Matcham F, Barbui C, Ostuzzi G. Antidepressants for the treatment of depression in people with cancer. Cochrane Database Syst Rev 2023; 3:CD011006. [PMID: 36999619 PMCID: PMC10065046 DOI: 10.1002/14651858.cd011006.pub4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
BACKGROUND Major depression and other depressive conditions are common in people with cancer. These conditions are not easily detectable in clinical practice, due to the overlap between medical and psychiatric symptoms, as described by diagnostic manuals such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD). Moreover, it is particularly challenging to distinguish between pathological and normal reactions to such a severe illness. Depressive symptoms, even in subthreshold manifestations, have a negative impact in terms of quality of life, compliance with anticancer treatment, suicide risk and possibly the mortality rate for the cancer itself. Randomised controlled trials (RCTs) on the efficacy, tolerability and acceptability of antidepressants in this population are few and often report conflicting results. OBJECTIVES To evaluate the efficacy, tolerability and acceptability of antidepressants for treating depressive symptoms in adults (aged 18 years or older) with cancer (any site and stage). SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was November 2022. SELECTION CRITERIA We included RCTs comparing antidepressants versus placebo, or antidepressants versus other antidepressants, in adults (aged 18 years or above) with any primary diagnosis of cancer and depression (including major depressive disorder, adjustment disorder, dysthymic disorder or depressive symptoms in the absence of a formal diagnosis). DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcome was 1. efficacy as a continuous outcome. Our secondary outcomes were 2. efficacy as a dichotomous outcome, 3. Social adjustment, 4. health-related quality of life and 5. dropouts. We used GRADE to assess certainty of evidence for each outcome. MAIN RESULTS We identified 14 studies (1364 participants), 10 of which contributed to the meta-analysis for the primary outcome. Six of these compared antidepressants and placebo, three compared two antidepressants, and one three-armed study compared two antidepressants and placebo. In this update, we included four additional studies, three of which contributed data for the primary outcome. For acute-phase treatment response (six to 12 weeks), antidepressants may reduce depressive symptoms when compared with placebo, even though the evidence is very uncertain. This was true when depressive symptoms were measured as a continuous outcome (standardised mean difference (SMD) -0.52, 95% confidence interval (CI) -0.92 to -0.12; 7 studies, 511 participants; very low-certainty evidence) and when measured as a proportion of people who had depression at the end of the study (risk ratio (RR) 0.74, 95% CI 0.57 to 0.96; 5 studies, 662 participants; very low-certainty evidence). No studies reported data on follow-up response (more than 12 weeks). In head-to-head comparisons, we retrieved data for selective serotonin reuptake inhibitors (SSRIs) versus tricyclic antidepressants (TCAs) and for mirtazapine versus TCAs. There was no difference between the various classes of antidepressants (continuous outcome: SSRI versus TCA: SMD -0.08, 95% CI -0.34 to 0.18; 3 studies, 237 participants; very low-certainty evidence; mirtazapine versus TCA: SMD -4.80, 95% CI -9.70 to 0.10; 1 study, 25 participants). There was a potential beneficial effect of antidepressants versus placebo for the secondary efficacy outcomes (continuous outcome, response at one to four weeks; very low-certainty evidence). There were no differences for these outcomes when comparing two different classes of antidepressants, even though the evidence was very uncertain. In terms of dropouts due to any cause, we found no difference between antidepressants compared with placebo (RR 0.85, 95% CI 0.52 to 1.38; 9 studies, 889 participants; very low-certainty evidence), and between SSRIs and TCAs (RR 0.83, 95% CI 0.53 to 1.22; 3 studies, 237 participants). We downgraded the certainty of the evidence because of the heterogeneous quality of the studies, imprecision arising from small sample sizes and wide CIs, and inconsistency due to statistical or clinical heterogeneity. AUTHORS' CONCLUSIONS Despite the impact of depression on people with cancer, the available studies were few and of low quality. This review found a potential beneficial effect of antidepressants against placebo in depressed participants with cancer. However, the certainty of evidence is very low and, on the basis of these results, it is difficult to draw clear implications for practice. The use of antidepressants in people with cancer should be considered on an individual basis and, considering the lack of head-to-head data, the choice of which drug to prescribe may be based on the data on antidepressant efficacy in the general population of people with major depression, also taking into account that data on people with other serious medical conditions suggest a positive safety profile for the SSRIs. Furthermore, this update shows that the usage of the newly US Food and Drug Administration-approved antidepressant esketamine in its intravenous formulation might represent a potential treatment for this specific population of people, since it can be used both as an anaesthetic and an antidepressant. However, data are too inconclusive and further studies are needed. We conclude that to better inform clinical practice, there is an urgent need for large, simple, randomised, pragmatic trials comparing commonly used antidepressants versus placebo in people with cancer who have depressive symptoms, with or without a formal diagnosis of a depressive disorder.
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Affiliation(s)
- Giovanni Vita
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Beatrice Compri
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Faith Matcham
- School of Psychology, University of Sussex, Brighton, UK
| | - Corrado Barbui
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giovanni Ostuzzi
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Alwhaibi A, Alsanea S, Almadi B, Al-Sabhan J, Alosaimi FD. Androgen deprivation therapy and depression in the prostate cancer patients: review of risk and pharmacological management. Aging Male 2022; 25:101-124. [PMID: 35343371 DOI: 10.1080/13685538.2022.2053954] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose: Despite the effectiveness of androgen deprivation therapy in advanced prostate cancer, serious neuropsychiatric consequences in androgen deprivation therapy (ADT)-treated patients, mainly depression, have been concerning and gained more attention recently. This narrative review aims to shed light on the risk and pharmacological management of ADT-induced depression in PCa patients.Methods: We searched PubMed, Scopus and Google Scholar databases using MESH keywords "Prostate cancer OR prostate neoplasm" AND "Depression" AND "Androgen Deprivation Therapy" AND "antidepressants". Search was limited to English and studies conducted on humans. Studies' titles and abstracts were screened, and further information were obtained from the text, if necessary, to decide whether studies are to be included in this review.Results: Our review revealed 23 studies confirming the occurrence and worsening of depressive symptoms in ADT-treated patients, which frequently require pharmacological interventions; whereas 10 studies indicated otherwise. All studies were prospective, retrospective, cross-sectional or case reports. Based on the incidence of depression provided by the observational studies, the average among ADT-treated patients was 18.23% (range: 2.1-46.9%), while it was 8.42% (range: 1.4-23.3%) in the non-ADT patients. Although several treatments have been used for depression in cancer patients, current knowledge lacks observational and controlled studies as well as clinical guidelines that demonstrate efficacy and safety of antidepressants and guide clinicians to the appropriate treatment in these patients, respectively. On the other side, a few clinical studies have been published regarding the efficacy of selective serotonin reuptake inhibitors, selective serotonin and norepinephrine reuptake inhibitors and/or saftey on other ADT associated adverse effects.Conclusions: Our work supports the recent attention towards mood issues as an adverse effect of ADT, and that greater awareness of this is warranted among clinicians. Clinical studies published regarding the use of antidepressants for other ADT associated adverse effects established the foundation that can be adopted to examine these therapies on ADT-induced depression.
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Affiliation(s)
- Abdulrahman Alwhaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Sary Alsanea
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Bana Almadi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Jawza Al-Sabhan
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Fahad D Alosaimi
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Affiliation(s)
- Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Livia Basile
- Department of Chemical Sciences, University of Catania, Catania, Italy
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Hutton B, Hersi M, Cheng W, Pratt M, Barbeau P, Mazzarello S, Ahmadzai N, Skidmore B, Morgan SC, Bordeleau L, Ginex PK, Sadeghirad B, Morgan RL, Cole KM, Clemons M. Comparing Interventions for Management of Hot Flashes in Patients With Breast and Prostate Cancer: A Systematic Review With Meta-Analyses. Oncol Nurs Forum 2021; 47:E86-E106. [PMID: 32555553 DOI: 10.1188/20.onf.e86-e106] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PROBLEM IDENTIFICATION Hot flashes are common and bothersome in patients with breast and prostate cancer and can adversely affect patients' quality of life. LITERATURE SEARCH Databases were searched for randomized controlled trials (RCTs) evaluating the effects of one or more interventions for hot flashes in patients with a history of breast or prostate cancer. DATA EVALUATION Outcomes of interest included changes in hot flash severity, hot flash frequency, quality of life, and harms. Pairwise meta-analyses and network meta-analyses were performed where feasible, with narrative synthesis used where required. SYNTHESIS 40 RCTs were included. Findings from network meta-analysis for hot flash frequency suggested that several therapies may offer benefits compared to no treatment, but little data suggested differences between active therapies. Findings from network meta-analysis for hot flash score were similar. IMPLICATIONS FOR RESEARCH Although many interventions may offer improvements for hot flashes versus no treatment, minimal data suggest important differences between therapies. SUPPLEMENTARY MATERIALS CAN BE FOUND BY VISITING HTTPS //bit.ly/2WGzi30.
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Marmitt DJ, Bitencourt S, Silva GRD, Rempel C, Goettert MI. RENISUS Plants and Their Potential Antitumor Effects in Clinical Trials and Registered Patents. Nutr Cancer 2020; 73:1821-1848. [PMID: 32835511 DOI: 10.1080/01635581.2020.1810290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 08/08/2020] [Accepted: 08/09/2020] [Indexed: 12/18/2022]
Abstract
Cancer is a significant cause of morbidity and mortality. Scientific advances, coupled with potential flaws in current treatments, are driving research into the discovery of new bioactive molecules. This systematic review focused on scientific studies with clinical trials and patents registered on the National Relation of Medicinal Plants of Interest to the Unified Health System (RENISUS) plants (or derivative compounds) with antitumor potential. Studies with 19 different forms of cancer were found, the prostate being the organ with the highest research incidence and the species Glycine max, Curcuma longa, and Zingiber officinale, beside the phytochemicals curcumin and soy isoflavone were the most tested in clinical trials/patents.
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Affiliation(s)
- Diorge Jônatas Marmitt
- Laboratório de Cultura de Células, Programa de Pós-graduação em Biotecnologia, Universidade do Vale do Taquari (Univates), Lajeado, Brazil
| | - Shanna Bitencourt
- Laboratório de Cultura de Células, Programa de Pós-graduação em Biotecnologia, Universidade do Vale do Taquari (Univates), Lajeado, Brazil
| | - Gustavo Rodrigo da Silva
- Centro de Ciências Biológicas e da Saúde, Universidade do Vale do Taquari (Univates), Lajeado, Brazil
| | - Claudete Rempel
- Programa de Pós-graduação em Ambiente e Desenvolvimento/Programa de Pós-graduação em Sistemas Ambientais Sustentáveis, Universidade do Vale do Taquari (Univates), Lajeado, Brazil
| | - Márcia Inês Goettert
- Laboratório de Cultura de Células, Programa de Pós-graduação em Biotecnologia, Universidade do Vale do Taquari (Univates), Lajeado, Brazil
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Kaplan M, Ginex PK, Michaud LB, Fernández-Ortega P, Leibelt J, Mahon S, Rapoport BL, Robinson V, Maloney C, Moriarty KA, Vrabel M, Morgan RL. ONS Guidelines™ for Cancer Treatment-Related Hot Flashes in Women With Breast Cancer and Men With Prostate Cancer. Oncol Nurs Forum 2020; 47:374-399. [PMID: 32555554 DOI: 10.1188/20.onf.374-399] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Hot flashes are a common and troublesome side effect of surgery or endocrine therapy. They may lead to physical and psychological distress and negatively affect quality of life. This clinical practice guideline presents evidence-based recommendations for pharmacologic, behavioral, and natural health product interventions for treatment-related hot flashes in patients with breast or prostate cancer. METHODOLOGIC APPROACH An interprofessional panel of healthcare professionals with patient representation prioritized clinical questions and patient outcomes for the management of hot flashes. Systematic reviews of the literature were conducted. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach was used to assess the evidence and make recommendations. FINDINGS The panel agreed on 14 pharmacologic, behavioral, and natural health recommendations. IMPLICATIONS FOR NURSING Conditional recommendations include the use of antidepressants rather than no treatment, physical activity rather than no treatment, and the avoidance of gabapentin and dietary supplements in the treatment of hot flashes. SUPPLEMENTARY MATERIAL CAN BE FOUND AT HTTPS //onf.ons.org/ons-guidelines-hot-flashes-supplementary-material.
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The effectiveness of lifestyle interventions to reduce side effects of androgen deprivation therapy for men with prostate cancer: a systematic review. Qual Life Res 2019; 29:843-865. [PMID: 31832978 PMCID: PMC7142057 DOI: 10.1007/s11136-019-02361-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2019] [Indexed: 12/18/2022]
Abstract
Purpose The aim of this review is to systematically review randomized controlled trials on lifestyle interventions on PCa patients undergoing androgen deprivation therapy. Methods A literature search was conducted using the electronic databases Medline and PubMed. To be eligible, studies had to be randomized controlled trials (RCTs) that focused on side effects of ADT and lifestyle interventions to reduce side effects for men undergoing ADT with PCa. Lifestyle interventions were defined as interventions that included any dietary or behavioral components. Results Twenty-nine trials were included. Most of them focused on exercise interventions, while some investigated the effect of dietary or behavioral interventions. The effect of different lifestyle influencing modalities aimed to improve on the adverse effects of ADT varied greatly. Conclusions It is not possible to draw one conclusion on the effect of exercise-based interventions, but noted on several adverse effects of ADT improvement. Further studies are necessary to develop personalized lifestyle interventions in order to mitigate the adverse effects.
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13
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Diet and lifestyle considerations for patients with prostate cancer. Urol Oncol 2019; 38:105-117. [PMID: 31327752 DOI: 10.1016/j.urolonc.2019.06.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 06/10/2019] [Accepted: 06/21/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE To review the literature and provide recommendations on diet and lifestyle considerations in patients with prostate cancer using evidence from randomized controlled trials (RCTs) with additional considerations based on observational evidence. MATERIALS AND METHODS We initiated our search on ClinicalTrials.gov combining the term "prostate cancer" with a variety of diet and lifestyle factors. We then supplemented our summary of publications from registered trials by including other publications available on Pubmed. RESULTS There is a well-established benefit of exercise for improving functional outcomes and pelvic floor muscle training for improving treatment-related adverse effects. Multimodality interventions that integrate several factors (e.g., low-saturated fat, plant-based, whole-food diets with exercise, and stress reduction) appear to have the most clinically significant benefit for patients with prostate cancer. Ongoing multimodality interventions are including the efficacy of implementation strategies as observed outcomes. Limited RCT evidence suggests a clinically significant benefit for guided imagery/progressive muscle relaxation, Pilates, and lycopene-rich diets and a modest benefit for green tea, qigong, massage, and avoidance of nonprescribed vitamin and mineral supplements. Observational and single arm trial evidence indicates a need for further exploration of acupuncture, coffee, cruciferous vegetables, fish, Larrea tridentata, mushrooms, and vegetable-derived fats and avoidance of eggs, dairy, poultry with skin, processed red meat, and saturated fat. Published trials suggest no benefit from hypnosis, milk thistle, pomegranate, soy, or omega-3 fatty acid supplementation. CONCLUSIONS Our search demonstrated that most diet and lifestyle factors identified from observational studies have limited data from RCTs. Few items have shown early evidence of benefit. The best recommendation for patients with prostate cancer is to form a habit of wellness through healthy eating, aerobic and resistance exercise, and psychological well-being. Future trial development should consider how interventions can be implemented into real world practice.
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Ostuzzi G, Matcham F, Dauchy S, Barbui C, Hotopf M. Antidepressants for the treatment of depression in people with cancer. Cochrane Database Syst Rev 2018; 4:CD011006. [PMID: 29683474 PMCID: PMC6494588 DOI: 10.1002/14651858.cd011006.pub3] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Major depression and other depressive conditions are common in people with cancer. These conditions are not easily detectable in clinical practice, due to the overlap between medical and psychiatric symptoms, as described by diagnostic manuals such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD). Moreover, it is particularly challenging to distinguish between pathological and normal reactions to such a severe illness. Depressive symptoms, even in subthreshold manifestations, have been shown to have a negative impact in terms of quality of life, compliance with anti-cancer treatment, suicide risk and likely even the mortality rate for the cancer itself. Randomised controlled trials (RCTs) on the efficacy, tolerability and acceptability of antidepressants in this population are few and often report conflicting results. OBJECTIVES To assess the efficacy, tolerability and acceptability of antidepressants for treating depressive symptoms in adults (aged 18 years or older) with cancer (any site and stage). SEARCH METHODS We searched the following electronic bibliographic databases: the Cochrane Central Register of Controlled Trials (CENTRAL 2017, Issue 6), MEDLINE Ovid (1946 to June week 4 2017), Embase Ovid (1980 to 2017 week 27) and PsycINFO Ovid (1987 to July week 4 2017). We additionally handsearched the trial databases of the most relevant national, international and pharmaceutical company trial registers and drug-approving agencies for published, unpublished and ongoing controlled trials. SELECTION CRITERIA We included RCTs comparing antidepressants versus placebo, or antidepressants versus other antidepressants, in adults (aged 18 years or above) with any primary diagnosis of cancer and depression (including major depressive disorder, adjustment disorder, dysthymic disorder or depressive symptoms in the absence of a formal diagnosis). DATA COLLECTION AND ANALYSIS Two review authors independently checked eligibility and extracted data using a form specifically designed for the aims of this review. The two authors compared the data extracted and then entered data into Review Manager 5 using a double-entry procedure. Information extracted included study and participant characteristics, intervention details, outcome measures for each time point of interest, cost analysis and sponsorship by a drug company. We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We retrieved a total of 10 studies (885 participants), seven of which contributed to the meta-analysis for the primary outcome. Four of these compared antidepressants and placebo, two compared two antidepressants, and one three-armed study compared two antidepressants and placebo. In this update we included one additional unpublished study. These new data contributed to the secondary analysis, while the results of the primary analysis remained unchanged.For acute-phase treatment response (6 to 12 weeks), we found no difference between antidepressants as a class and placebo on symptoms of depression measured both as a continuous outcome (standardised mean difference (SMD) -0.45, 95% confidence interval (CI) -1.01 to 0.11, five RCTs, 266 participants; very low certainty evidence) and as a proportion of people who had depression at the end of the study (risk ratio (RR) 0.82, 95% CI 0.62 to 1.08, five RCTs, 417 participants; very low certainty evidence). No trials reported data on follow-up response (more than 12 weeks). In head-to-head comparisons we only retrieved data for selective serotonin reuptake inhibitors (SSRIs) versus tricyclic antidepressants, showing no difference between these two classes (SMD -0.08, 95% CI -0.34 to 0.18, three RCTs, 237 participants; very low certainty evidence). No clear evidence of a beneficial effect of antidepressants versus either placebo or other antidepressants emerged from our analyses of the secondary efficacy outcomes (dichotomous outcome, response at 6 to 12 weeks, very low certainty evidence). In terms of dropouts due to any cause, we found no difference between antidepressants as a class compared with placebo (RR 0.85, 95% CI 0.52 to 1.38, seven RCTs, 479 participants; very low certainty evidence), and between SSRIs and tricyclic antidepressants (RR 0.83, 95% CI 0.53 to 1.30, three RCTs, 237 participants). We downgraded the certainty (quality) of the evidence because the included studies were at an unclear or high risk of bias due to poor reporting, imprecision arising from small sample sizes and wide confidence intervals, and inconsistency due to statistical or clinical heterogeneity. AUTHORS' CONCLUSIONS Despite the impact of depression on people with cancer, the available studies were very few and of low quality. This review found very low certainty evidence for the effects of these drugs compared with placebo. On the basis of these results, clear implications for practice cannot be deduced. The use of antidepressants in people with cancer should be considered on an individual basis and, considering the lack of head-to-head data, the choice of which agent to prescribe may be based on the data on antidepressant efficacy in the general population of individuals with major depression, also taking into account that data on medically ill patients suggest a positive safety profile for the SSRIs. To better inform clinical practice, there is an urgent need for large, simple, randomised, pragmatic trials comparing commonly used antidepressants versus placebo in people with cancer who have depressive symptoms, with or without a formal diagnosis of a depressive disorder.
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Affiliation(s)
- Giovanni Ostuzzi
- University of VeronaDepartment of Neuroscience, Biomedicine and Movement Sciences, Section of PsychiatryPoliclinico "GB Rossi"Piazzale L.A. Scuro, 10VeronaItaly37134
| | - Faith Matcham
- The Institute of Psychiatry, King's College LondonDepartment of Psychological MedicineWeston Education CentreLondonUKSE5 9RJ
| | - Sarah Dauchy
- Gustave RoussyChef du Département Interdisciplinaire de Soins de Support114 rue Edouard VaillantVillejuifParisFrance94805
| | - Corrado Barbui
- University of VeronaDepartment of Neuroscience, Biomedicine and Movement Sciences, Section of PsychiatryVeronaItaly
| | - Matthew Hotopf
- The Institute of Psychiatry, King's College LondonDepartment of Psychological MedicineWeston Education CentreLondonUKSE5 9RJ
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Foucher Y, Lorent M, Tessier P, Supiot S, Sébille V, Dantan E. A mini-review of quality of life as an outcome in prostate cancer trials: patient-centered approaches are needed to propose appropriate treatments on behalf of patients. Health Qual Life Outcomes 2018; 16:40. [PMID: 29506537 PMCID: PMC5836440 DOI: 10.1186/s12955-018-0870-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 02/26/2018] [Indexed: 12/18/2022] Open
Abstract
Background Patients with prostate cancer (PC) may be ready to make trade-offs between their quantity and their quality of life. For instance, elderly patients may prefer the absence of treatment if it is associated with a low-risk of disease progression, compared to treatments aiming at preventing disease progression but with a substantial deterioration of their Health-Related Quality of Life (HRQoL). Therefore, it seems relevant to compare the treatments by considering both survival and HRQoL. In this mini-review, the aim was to question whether the potential trade-offs between survival and HRQoL are considered in high impact factor journals. Methods The study was conducted from the PubMed database for recent papers published between May 01, 2013, and May 01, 2015. We also restricted our search to nine medical journals with 2013 impact factor > 15. Results Among the 30 selected studies, only six collected individual HRQoL as a secondary endpoint by using the Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire. In four studies, the time to HRQoL change was analyzed, but its definitions varied. In two studies, the mean changes in HRQoL between the baseline and the 12- or 16-week follow-up were analyzed. None of the six studies reported in a single endpoint both the quantity and the quality of life. Conclusions Our mini-review, which only focused on recent publications in journals with high-impact, suggests moving PC clinical research towards patient-centered outcomes-based studies. This may help physicians to propose the most appropriate treatment on behalf of patients. We recommend the use of indicators such as Quality-Adjusted Life-Years (QALYs) as principal endpoint in future clinical trials. Electronic supplementary material The online version of this article (10.1186/s12955-018-0870-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yohann Foucher
- SPHERE (MethodS for Patients-centered outcomes and HEalth Research), INSERM UMR 1246, Nantes University, IRS2 - 22 boulevard Bénoni Goullin, 44200, Nantes, France. .,CHU Nantes University Hospital, Nantes, France.
| | - Marine Lorent
- SPHERE (MethodS for Patients-centered outcomes and HEalth Research), INSERM UMR 1246, Nantes University, IRS2 - 22 boulevard Bénoni Goullin, 44200, Nantes, France
| | - Philippe Tessier
- SPHERE (MethodS for Patients-centered outcomes and HEalth Research), INSERM UMR 1246, Nantes University, IRS2 - 22 boulevard Bénoni Goullin, 44200, Nantes, France.,CHU Nantes University Hospital, Nantes, France
| | - Stéphane Supiot
- ICO - Institut de Cancérologie de l'Ouest - Centre René Gauducheau, Boulevard Jacques Monod, 44805, Saint-Herblain, France
| | - Véronique Sébille
- SPHERE (MethodS for Patients-centered outcomes and HEalth Research), INSERM UMR 1246, Nantes University, IRS2 - 22 boulevard Bénoni Goullin, 44200, Nantes, France.,CHU Nantes University Hospital, Nantes, France
| | - Etienne Dantan
- SPHERE (MethodS for Patients-centered outcomes and HEalth Research), INSERM UMR 1246, Nantes University, IRS2 - 22 boulevard Bénoni Goullin, 44200, Nantes, France
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Carter J, Lacchetti C, Andersen BL, Barton DL, Bolte S, Damast S, Diefenbach MA, DuHamel K, Florendo J, Ganz PA, Goldfarb S, Hallmeyer S, Kushner DM, Rowland JH. Interventions to Address Sexual Problems in People With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Adaptation of Cancer Care Ontario Guideline. J Clin Oncol 2018; 36:492-511. [DOI: 10.1200/jco.2017.75.8995] [Citation(s) in RCA: 148] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Purpose The adaptation of the Cancer Care Ontario (CCO) guideline Interventions to Address Sexual Problems in People With Cancer provides recommendations to manage sexual function adverse effects that occur as a result of cancer diagnosis and/or treatment. Methods ASCO staff reviewed the guideline for developmental rigor and updated the literature search. An ASCO Expert Panel ( Table A1 ) was assembled to review the guideline content and recommendations. Results The ASCO Expert Panel determined that the recommendations from the 2016 CCO guideline are clear, thorough, and based upon the most relevant scientific evidence. ASCO statements and modifications were added to adapt the CCO guideline for a broader audience. Recommendations It is recommended that there be a discussion with the patient, initiated by a member of the health care team, regarding sexual health and dysfunction resulting from cancer or its treatment. Psychosocial and/or psychosexual counseling should be offered to all patients with cancer, aiming to improve sexual response, body image, intimacy and relationship issues, and overall sexual functioning and satisfaction. Medical and treatable contributing factors should be identified and addressed first. In women with symptoms of vaginal and/or vulvar atrophy, lubricants in addition to vaginal moisturizers may be tried as a first option. Low-dose vaginal estrogen, lidocaine, and dehydroepiandrosterone may also be considered in some cases. In men, medication such as phosphodiesterase type 5 inhibitors may be beneficial, and surgery remains an option for those with symptoms or treatment complications refractory to medical management. Both women and men experiencing vasomotor symptoms should be offered interventions for symptomatic improvement, including behavioral options such as cognitive behavioral therapy, slow breathing and hypnosis, and medications such as venlafaxine and gabapentin.Additional information is available at: www.asco.org/survivorship-guidelines and www.asco.org/guidelineswiki .
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Affiliation(s)
- Jeanne Carter
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Christina Lacchetti
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Barbara L. Andersen
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Debra L. Barton
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Sage Bolte
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Shari Damast
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Michael A. Diefenbach
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Katherine DuHamel
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Judith Florendo
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Patricia A. Ganz
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Shari Goldfarb
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Sigrun Hallmeyer
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - David M. Kushner
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Julia H. Rowland
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
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Top ten errors of statistical analysis in observational studies for cancer research. Clin Transl Oncol 2017; 20:954-965. [PMID: 29218627 DOI: 10.1007/s12094-017-1817-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 11/27/2017] [Indexed: 12/13/2022]
Abstract
Observational studies using registry data make it possible to compile quality information and can surpass clinical trials in some contexts. However, data heterogeneity, analytical complexity, and the diversity of aspects to be taken into account when interpreting results makes it easy for mistakes to be made and calls for mastery of statistical methodology. Some questionable research practices that include poor analytical data management are responsible for the low reproducibility of some results; yet, there is a paucity of information in the literature regarding specific statistical pitfalls of cancer studies. In addition to proposing how to avoid or solve them, this article seeks to expose ten common problematic situations in the analysis of cancer registries: convenience, dichotomization, stratification, regression to the mean, impact of sample size, competing risks, immortal time and survivor bias, management of missing values, and data dredging.
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The Effect of Nutrition Therapy and Exercise on Cancer-Related Fatigue and Quality of Life in Men with Prostate Cancer: A Systematic Review. Nutrients 2017; 9:nu9091003. [PMID: 28895922 PMCID: PMC5622763 DOI: 10.3390/nu9091003] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 08/15/2017] [Accepted: 09/07/2017] [Indexed: 12/16/2022] Open
Abstract
Background: Improvements in diet and/or exercise are often advocated during prostate cancer treatment, yet the efficacy of, and optimal nutrition and exercise prescription for managing cancer-related fatigue and quality of life remains elusive. The aim of this study is to systematically review the effects of nutrition and/or exercise on cancer-related fatigue and/or quality of life. Methods: A literature search was conducted in six electronic databases. The Delphi quality assessment list was used to evaluate the methodological quality of the literature. The study characteristics and results were summarized in accordance with the review’s Population, Intervention, Control, Outcome (PICO) criteria. Results: A total of 20 articles (one diet only, two combined diet and exercise, and seventeen exercise only studies) were included in the review. Soy supplementation improved quality of life, but resulted in several adverse effects. Prescribing healthy eating guidelines with combined resistance training and aerobic exercise improved cancer-related fatigue, yet its effect on quality of life was inconclusive. Combined resistance training with aerobic exercise showed improvements in cancer-related fatigue and quality of life. In isolation, resistance training appears to be more effective in improving cancer-related fatigue and quality of life than aerobic exercise. Studies that utilised an exercise professional to supervise the exercise sessions were more likely to report improvements in both cancer-related fatigue and quality of life than those prescribing unsupervised or partially supervised sessions. Neither exercise frequency nor duration appeared to influence cancer-related fatigue or quality of life, with further research required to explore the potential dose-response effect of exercise intensity. Conclusion: Supervised moderate-hard resistance training with or without moderate-vigorous aerobic exercise appears to improve cancer-related fatigue and quality of life. Targeted physiological pathways suggest dietary intervention may alleviate cancer-related fatigue and improve quality of life, however the efficacy of nutrition management with or without exercise prescription requires further exploration.
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Rosario DJ, Greasley R, Bourke L. Castration-resistant Prostate Cancer: Preservation of Quality of Life and Well-being. Eur Urol Focus 2017; 2:472-475. [PMID: 28723509 DOI: 10.1016/j.euf.2016.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 08/30/2016] [Indexed: 12/21/2022]
Abstract
Managing optimal health in castrate-resistant prostate cancer is a complex clinical challenge. Quality of life should be assessed with disease-specific validated tools and can be used in clinical practice to assist in considering management options.
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Affiliation(s)
- Derek J Rosario
- Department of Oncology, University of Sheffield, Sheffield, UK
| | - Rosa Greasley
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Liam Bourke
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK.
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Barbera L, Zwaal C, Elterman D, McPherson K, Wolfman W, Katz A, Matthew A. Interventions to address sexual problems in people with cancer. Curr Oncol 2017; 24:192-200. [PMID: 28680280 PMCID: PMC5486385 DOI: 10.3747/co.24.3583] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Sexual dysfunction in people with cancer is a significant problem. The present clinical practice guideline makes recommendations to improve sexual function in people with cancer. METHODS This guideline was undertaken by the Interventions to Address Sexual Problems in People with Cancer Expert Panel, a group organized by the Program in Evidence-Based Care (pebc). Consistent with the pebc standardized approach, a systematic search was conducted for existing guidelines, and the literature in medline and embase for the years 2003-2015 was systematically searched for both systematic reviews and primary literature. Evidence found for men and for women was evaluated separately, and no restrictions were placed on cancer type or study design. Content and methodology experts performed an internal review of the resulting draft recommendations, which was followed by an external review by targeted experts and intended users. RESULTS The search identified 4 existing guidelines, 13 systematic reviews, and 103 studies with relevance to the topic. The present guideline provides one overarching recommendation concerning the discussion of sexual health and dysfunction, which is aimed at all people with cancer. Eleven additional recommendations made separately for men and women deal with issues such as sexual response, body image, intimacy and relationships, overall sexual functioning and satisfaction, and vasomotor and genital symptoms. CONCLUSIONS To our knowledge this clinical practice guideline is the first to comprehensively evaluate interventions for the improvement of sexual problems in people with cancer. The guideline will be a valuable resource to support practitioners and clinics in addressing sexuality in cancer survivors.
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Affiliation(s)
- L. Barbera
- Department of Radiation Oncology, University of Toronto, Toronto
| | - C. Zwaal
- Program in Evidence-Based Care, Cancer Care Ontario, Hamilton
| | - D. Elterman
- Department of Surgery, Division of Urology, University of Toronto, Toronto
| | - K. McPherson
- Patient and Family Advisory Council, Cancer Care Ontario, Hamilton; and
| | - W. Wolfman
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON; and
| | - A. Katz
- CancerCare Manitoba, Winnipeg, MB
| | - A. Matthew
- Department of Surgery, Division of Urology, University of Toronto, Toronto
| | - The Interventions to Address Sexual Problems in People with Cancer Guideline Development Group
- Department of Radiation Oncology, University of Toronto, Toronto
- Program in Evidence-Based Care, Cancer Care Ontario, Hamilton
- Department of Surgery, Division of Urology, University of Toronto, Toronto
- Patient and Family Advisory Council, Cancer Care Ontario, Hamilton; and
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON; and
- CancerCare Manitoba, Winnipeg, MB
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21
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Assessment of quality of life in advanced, metastatic prostate cancer: an overview of randomized phase III trials. Qual Life Res 2016; 26:813-822. [DOI: 10.1007/s11136-016-1429-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2016] [Indexed: 11/12/2022]
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22
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Faubion SS, Loprinzi CL, Ruddy KJ. Management of Hormone Deprivation Symptoms After Cancer. Mayo Clin Proc 2016; 91:1133-46. [PMID: 27492917 DOI: 10.1016/j.mayocp.2016.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/03/2016] [Accepted: 04/05/2016] [Indexed: 02/08/2023]
Abstract
Cancer survivors often experience symptoms related to hormone deprivation, including vasomotor symptoms, genitourinary symptoms, and sexual health concerns. These symptoms can occur due to natural menopause in midlife women, or they can be brought on by oncologic therapies in younger women or men. We searched PubMed for English-language studies from January 1990 through January 2016 to identify relevant articles on the management of hormone deprivation symptoms, including vasomotor, genitourinary, and sexual symptoms in patients with cancer. The search terms used included hormone deprivation, vasomotor symptoms, hot flash, vaginal dryness, sexual dysfunction, and breast cancer. This manuscript provides a comprehensive description of data supporting the treatment of symptoms associated with hormone deprivation.
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Affiliation(s)
- Stephanie S Faubion
- Women's Health Clinic, Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.
| | - Charles L Loprinzi
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN
| | - Kathryn J Ruddy
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN
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23
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Teleni L, Chan RJ, Chan A, Isenring EA, Vela I, Inder WJ, McCarthy AL. Exercise improves quality of life in androgen deprivation therapy-treated prostate cancer: systematic review of randomised controlled trials. Endocr Relat Cancer 2016; 23:101-12. [PMID: 26584972 DOI: 10.1530/erc-15-0456] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2015] [Indexed: 11/08/2022]
Abstract
Men receiving androgen deprivation therapy (ADT) for prostate cancer (PCa) are likely to develop metabolic conditions such as diabetes, cardiovascular disease, abdominal obesity and osteoporosis. Other treatment-related side effects adversely influence quality of life (QoL) including vasomotor distress, depression, anxiety, mood swings, poor sleep quality and compromised sexual function. The objective of this study was to systematically review the nature and effects of dietary and exercise interventions on QoL, androgen deprivation symptoms and metabolic risk factors in men with PCa undergoing ADT. An electronic search of CINAHL, CENTRAL, Medline, PsychINFO and reference lists was performed to identify peer-reviewed articles published between January 2004 and December 2014 in English. Eligible study designs included randomised controlled trials (RCTs) with pre- and post-intervention data. Data extraction and assessment of methodological quality with the Cochrane approach was conducted by two independent reviewers. Seven exercise studies were identified. Exercise significantly improved QoL, but showed no effect on metabolic risk factors (weight, waist circumference, lean or fat mass, blood pressure and lipid profile). Two dietary studies were identified, both of which tested soy supplements. Soy supplementation did not improve any outcomes. No dietary counselling studies were identified. No studies evaluated androgen-deficiency symptoms (libido, erectile function, sleep quality, mood swings, depression, anxiety and bone mineral density). Evidence from RCTs indicates that exercise enhances health- and disease-specific QoL in men with PCa undergoing ADT. Further studies are required to evaluate the effect of exercise and dietary interventions on QoL, androgen deprivation symptoms and metabolic risk factors in this cohort.
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Affiliation(s)
- Laisa Teleni
- School of NursingQueensland University of Technology, Brisbane, Queensland, AustraliaFaculty of Health Sciences and MedicineBond Institute of Health and Sport, Bond University, 2 Promethean Way, Gold Coast, Queensland 4226, AustraliaWest Moreton Hospital and Health ServiceBrisbane, Queensland, AustraliaDepartment of PharmacyFaculty of Science, National University of ingapore, Singapore, SingaporeOncology PharmacyNational Cancer Centre Singapore, Singapore, SingaporeDepartment of Nutrition and DieteticsPrincess lexandra Hospital, Brisbane, Queensland, AustraliaDepartment of UrologyPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaAustralian Prostate Cancer Research Centre - QueenslandBrisbane, Queensland, AustraliaDepartment of Diabetes and EndocrinologyPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaSchool of MedicineThe University of Queensland, Brisbane, Queensland, AustraliaDivision of Cancer ServicesPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaInstitute of Health and Biomedical InnovationQueensland University of Technology, Brisbane, Queensland, Australia School of NursingQueensland University of Technology, Brisbane, Queensland, AustraliaFaculty of Health Sciences and MedicineBond Institute of Health and Sport, Bond University, 2 Promethean Way, Gold Coast, Queensland 4226, AustraliaWest Moreton Hospital and Health ServiceBrisbane, Queensland, AustraliaDepartment of PharmacyFaculty of Science, National University of ingapore, Singapore, SingaporeOncology PharmacyNational Cancer Centre Singapore, Singapore, SingaporeDepartment of Nutrition and DieteticsPrincess lexandra Hospital, Brisbane, Queensland, AustraliaDepartment of UrologyPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaAustralian Prostate Cancer Research Centre - QueenslandBrisbane, Queensland, AustraliaDepartment of Diabetes and EndocrinologyPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaSchool of MedicineThe University of Queensland, Brisba
| | - Raymond J Chan
- School of NursingQueensland University of Technology, Brisbane, Queensland, AustraliaFaculty of Health Sciences and MedicineBond Institute of Health and Sport, Bond University, 2 Promethean Way, Gold Coast, Queensland 4226, AustraliaWest Moreton Hospital and Health ServiceBrisbane, Queensland, AustraliaDepartment of PharmacyFaculty of Science, National University of ingapore, Singapore, SingaporeOncology PharmacyNational Cancer Centre Singapore, Singapore, SingaporeDepartment of Nutrition and DieteticsPrincess lexandra Hospital, Brisbane, Queensland, AustraliaDepartment of UrologyPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaAustralian Prostate Cancer Research Centre - QueenslandBrisbane, Queensland, AustraliaDepartment of Diabetes and EndocrinologyPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaSchool of MedicineThe University of Queensland, Brisbane, Queensland, AustraliaDivision of Cancer ServicesPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaInstitute of Health and Biomedical InnovationQueensland University of Technology, Brisbane, Queensland, Australia School of NursingQueensland University of Technology, Brisbane, Queensland, AustraliaFaculty of Health Sciences and MedicineBond Institute of Health and Sport, Bond University, 2 Promethean Way, Gold Coast, Queensland 4226, AustraliaWest Moreton Hospital and Health ServiceBrisbane, Queensland, AustraliaDepartment of PharmacyFaculty of Science, National University of ingapore, Singapore, SingaporeOncology PharmacyNational Cancer Centre Singapore, Singapore, SingaporeDepartment of Nutrition and DieteticsPrincess lexandra Hospital, Brisbane, Queensland, AustraliaDepartment of UrologyPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaAustralian Prostate Cancer Research Centre - QueenslandBrisbane, Queensland, AustraliaDepartment of Diabetes and EndocrinologyPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaSchool of MedicineThe University of Queensland, Brisba
| | - Alexandre Chan
- School of NursingQueensland University of Technology, Brisbane, Queensland, AustraliaFaculty of Health Sciences and MedicineBond Institute of Health and Sport, Bond University, 2 Promethean Way, Gold Coast, Queensland 4226, AustraliaWest Moreton Hospital and Health ServiceBrisbane, Queensland, AustraliaDepartment of PharmacyFaculty of Science, National University of ingapore, Singapore, SingaporeOncology PharmacyNational Cancer Centre Singapore, Singapore, SingaporeDepartment of Nutrition and DieteticsPrincess lexandra Hospital, Brisbane, Queensland, AustraliaDepartment of UrologyPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaAustralian Prostate Cancer Research Centre - QueenslandBrisbane, Queensland, AustraliaDepartment of Diabetes and EndocrinologyPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaSchool of MedicineThe University of Queensland, Brisbane, Queensland, AustraliaDivision of Cancer ServicesPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaInstitute of Health and Biomedical InnovationQueensland University of Technology, Brisbane, Queensland, Australia School of NursingQueensland University of Technology, Brisbane, Queensland, AustraliaFaculty of Health Sciences and MedicineBond Institute of Health and Sport, Bond University, 2 Promethean Way, Gold Coast, Queensland 4226, AustraliaWest Moreton Hospital and Health ServiceBrisbane, Queensland, AustraliaDepartment of PharmacyFaculty of Science, National University of ingapore, Singapore, SingaporeOncology PharmacyNational Cancer Centre Singapore, Singapore, SingaporeDepartment of Nutrition and DieteticsPrincess lexandra Hospital, Brisbane, Queensland, AustraliaDepartment of UrologyPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaAustralian Prostate Cancer Research Centre - QueenslandBrisbane, Queensland, AustraliaDepartment of Diabetes and EndocrinologyPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaSchool of MedicineThe University of Queensland, Brisba
| | - Elisabeth A Isenring
- School of NursingQueensland University of Technology, Brisbane, Queensland, AustraliaFaculty of Health Sciences and MedicineBond Institute of Health and Sport, Bond University, 2 Promethean Way, Gold Coast, Queensland 4226, AustraliaWest Moreton Hospital and Health ServiceBrisbane, Queensland, AustraliaDepartment of PharmacyFaculty of Science, National University of ingapore, Singapore, SingaporeOncology PharmacyNational Cancer Centre Singapore, Singapore, SingaporeDepartment of Nutrition and DieteticsPrincess lexandra Hospital, Brisbane, Queensland, AustraliaDepartment of UrologyPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaAustralian Prostate Cancer Research Centre - QueenslandBrisbane, Queensland, AustraliaDepartment of Diabetes and EndocrinologyPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaSchool of MedicineThe University of Queensland, Brisbane, Queensland, AustraliaDivision of Cancer ServicesPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaInstitute of Health and Biomedical InnovationQueensland University of Technology, Brisbane, Queensland, Australia School of NursingQueensland University of Technology, Brisbane, Queensland, AustraliaFaculty of Health Sciences and MedicineBond Institute of Health and Sport, Bond University, 2 Promethean Way, Gold Coast, Queensland 4226, AustraliaWest Moreton Hospital and Health ServiceBrisbane, Queensland, AustraliaDepartment of PharmacyFaculty of Science, National University of ingapore, Singapore, SingaporeOncology PharmacyNational Cancer Centre Singapore, Singapore, SingaporeDepartment of Nutrition and DieteticsPrincess lexandra Hospital, Brisbane, Queensland, AustraliaDepartment of UrologyPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaAustralian Prostate Cancer Research Centre - QueenslandBrisbane, Queensland, AustraliaDepartment of Diabetes and EndocrinologyPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaSchool of MedicineThe University of Queensland, Brisba
| | - Ian Vela
- School of NursingQueensland University of Technology, Brisbane, Queensland, AustraliaFaculty of Health Sciences and MedicineBond Institute of Health and Sport, Bond University, 2 Promethean Way, Gold Coast, Queensland 4226, AustraliaWest Moreton Hospital and Health ServiceBrisbane, Queensland, AustraliaDepartment of PharmacyFaculty of Science, National University of ingapore, Singapore, SingaporeOncology PharmacyNational Cancer Centre Singapore, Singapore, SingaporeDepartment of Nutrition and DieteticsPrincess lexandra Hospital, Brisbane, Queensland, AustraliaDepartment of UrologyPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaAustralian Prostate Cancer Research Centre - QueenslandBrisbane, Queensland, AustraliaDepartment of Diabetes and EndocrinologyPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaSchool of MedicineThe University of Queensland, Brisbane, Queensland, AustraliaDivision of Cancer ServicesPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaInstitute of Health and Biomedical InnovationQueensland University of Technology, Brisbane, Queensland, Australia School of NursingQueensland University of Technology, Brisbane, Queensland, AustraliaFaculty of Health Sciences and MedicineBond Institute of Health and Sport, Bond University, 2 Promethean Way, Gold Coast, Queensland 4226, AustraliaWest Moreton Hospital and Health ServiceBrisbane, Queensland, AustraliaDepartment of PharmacyFaculty of Science, National University of ingapore, Singapore, SingaporeOncology PharmacyNational Cancer Centre Singapore, Singapore, SingaporeDepartment of Nutrition and DieteticsPrincess lexandra Hospital, Brisbane, Queensland, AustraliaDepartment of UrologyPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaAustralian Prostate Cancer Research Centre - QueenslandBrisbane, Queensland, AustraliaDepartment of Diabetes and EndocrinologyPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaSchool of MedicineThe University of Queensland, Brisba
| | - Warrick J Inder
- School of NursingQueensland University of Technology, Brisbane, Queensland, AustraliaFaculty of Health Sciences and MedicineBond Institute of Health and Sport, Bond University, 2 Promethean Way, Gold Coast, Queensland 4226, AustraliaWest Moreton Hospital and Health ServiceBrisbane, Queensland, AustraliaDepartment of PharmacyFaculty of Science, National University of ingapore, Singapore, SingaporeOncology PharmacyNational Cancer Centre Singapore, Singapore, SingaporeDepartment of Nutrition and DieteticsPrincess lexandra Hospital, Brisbane, Queensland, AustraliaDepartment of UrologyPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaAustralian Prostate Cancer Research Centre - QueenslandBrisbane, Queensland, AustraliaDepartment of Diabetes and EndocrinologyPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaSchool of MedicineThe University of Queensland, Brisbane, Queensland, AustraliaDivision of Cancer ServicesPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaInstitute of Health and Biomedical InnovationQueensland University of Technology, Brisbane, Queensland, Australia School of NursingQueensland University of Technology, Brisbane, Queensland, AustraliaFaculty of Health Sciences and MedicineBond Institute of Health and Sport, Bond University, 2 Promethean Way, Gold Coast, Queensland 4226, AustraliaWest Moreton Hospital and Health ServiceBrisbane, Queensland, AustraliaDepartment of PharmacyFaculty of Science, National University of ingapore, Singapore, SingaporeOncology PharmacyNational Cancer Centre Singapore, Singapore, SingaporeDepartment of Nutrition and DieteticsPrincess lexandra Hospital, Brisbane, Queensland, AustraliaDepartment of UrologyPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaAustralian Prostate Cancer Research Centre - QueenslandBrisbane, Queensland, AustraliaDepartment of Diabetes and EndocrinologyPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaSchool of MedicineThe University of Queensland, Brisba
| | - Alexandra L McCarthy
- School of NursingQueensland University of Technology, Brisbane, Queensland, AustraliaFaculty of Health Sciences and MedicineBond Institute of Health and Sport, Bond University, 2 Promethean Way, Gold Coast, Queensland 4226, AustraliaWest Moreton Hospital and Health ServiceBrisbane, Queensland, AustraliaDepartment of PharmacyFaculty of Science, National University of ingapore, Singapore, SingaporeOncology PharmacyNational Cancer Centre Singapore, Singapore, SingaporeDepartment of Nutrition and DieteticsPrincess lexandra Hospital, Brisbane, Queensland, AustraliaDepartment of UrologyPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaAustralian Prostate Cancer Research Centre - QueenslandBrisbane, Queensland, AustraliaDepartment of Diabetes and EndocrinologyPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaSchool of MedicineThe University of Queensland, Brisbane, Queensland, AustraliaDivision of Cancer ServicesPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaInstitute of Health and Biomedical InnovationQueensland University of Technology, Brisbane, Queensland, Australia School of NursingQueensland University of Technology, Brisbane, Queensland, AustraliaFaculty of Health Sciences and MedicineBond Institute of Health and Sport, Bond University, 2 Promethean Way, Gold Coast, Queensland 4226, AustraliaWest Moreton Hospital and Health ServiceBrisbane, Queensland, AustraliaDepartment of PharmacyFaculty of Science, National University of ingapore, Singapore, SingaporeOncology PharmacyNational Cancer Centre Singapore, Singapore, SingaporeDepartment of Nutrition and DieteticsPrincess lexandra Hospital, Brisbane, Queensland, AustraliaDepartment of UrologyPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaAustralian Prostate Cancer Research Centre - QueenslandBrisbane, Queensland, AustraliaDepartment of Diabetes and EndocrinologyPrincess Alexandra Hospital, Brisbane, Queensland, AustraliaSchool of MedicineThe University of Queensland, Brisba
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Baker BR, Mohiuddin JJ, Chen RC. Radiation with Hormonal Therapy. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00043-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
In 2014, prostate cancer will affect roughly 15 % of American men during their lifetimes with about 230,000 new cases and 29,000 deaths per year. If required, most can be treated with curative surgery or radiotherapy. Upon relapse, androgen deprivation therapy (intermittent or continuous) is the cornerstone of treatment for hormone-sensitive disease. Response is variable and treatment is associated with a significant risk of toxicity. Recently, significant advances in survival have been demonstrated with chemohormonal therapy in men with high-volume disease. In addition, new findings have informed the approach to preventing bone complications in patients on therapy for metastatic hormone-sensitive prostate cancer. Devising clinical prediction tools and biomarkers is needed to select patients most likely to benefit from certain therapies and allow for a personalized approach.
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Survivorship and Improving Quality of Life in Men with Prostate Cancer. Eur Urol 2015; 68:374-83. [DOI: 10.1016/j.eururo.2015.04.023] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/16/2015] [Indexed: 11/18/2022]
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Abstract
The combination of radiation treatment and long-term androgen deprivation therapy (ADT) has been shown in multiple clinical trials to prolong overall survival in men with high-risk prostate cancer compared with either treatment alone. New radiation technologies enable the safe delivery of high radiation doses that improve cancer control compared with lower radiation doses. Based on the results of multiple randomized trials, clinical practice guidelines for high-risk prostate cancer recommend total radiation doses of at least 75.6 Gy, with long-term (2-3 years) ADT. Ongoing research into hypofractionated radiation treatment, whole-pelvic radiation, and combinations of radiation with novel hormonal agents could further improve cancer control and survival outcomes for patients with high-risk prostate cancer.
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Drewe J, Bucher KA, Zahner C. A systematic review of non-hormonal treatments of vasomotor symptoms in climacteric and cancer patients. SPRINGERPLUS 2015; 4:65. [PMID: 25713759 PMCID: PMC4331402 DOI: 10.1186/s40064-015-0808-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 01/09/2015] [Indexed: 12/03/2022]
Abstract
The cardinal climacteric symptoms of hot flushes and night sweats affect 24-93% of all women during the physiological transition from reproductive to post-reproductive life. Though efficacious, hormonal therapy and partial oestrogenic compounds are linked to a significant increase in breast cancer. Non-hormonal treatments are thus greatly appreciated. This systematic review of published hormonal and non-hormonal treatments for climacteric, and breast and prostate cancer-associated hot flushes, examines clinical efficacy and therapy-related cancer risk modulation. A PubMed search included literature up to June 19, 2014 without limits for initial dates or language, with the search terms, (hot flush* OR hot flash*) AND (clinical trial* OR clinical stud*) AND (randomi* OR observational) NOT review). Retrieved references identified further papers. The focus was on hot flushes; other symptoms (night sweats, irritability, etc.) were not specifically screened. Included were some 610 clinical studies where a measured effect of the intervention, intensity and severity were documented, and where patients received treatment of pharmaceutical quality. Only 147 of these references described studies with alternative non-hormonal treatments in post-menopausal women and in breast and prostate cancer survivors; these results are presented in Additional file 1. The most effective hot flush treatment is oestrogenic hormones, or a combination of oestrogen and progestins, though benefits are partially outweighed by a significantly increased risk for breast cancer development. This review illustrates that certain non-hormonal treatments, including selective serotonin reuptake inhibitors, gabapentin/pregabalin, and Cimicifuga racemosa extracts, show a positive risk-benefit ratio. Key pointsSeveral non-hormonal alternatives to hormonal therapy have been established and registered for the treatment of vasomotor climacteric symptoms in peri- and post-menopausal women. There are indications that non-hormonal treatments are useful alternatives in patients with a history of breast and prostate cancer. However, confirmation by larger clinical trials is required.
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Affiliation(s)
- Juergen Drewe
- Max Zeller AG, Seeblickstr. 4, 8590 Romanshorn, Switzerland
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29
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Kaplan M, Mahon S. Hot Flash Management: Update of the Evidence for Patients With Cancer. Clin J Oncol Nurs 2014; 18 Suppl:59-67. [DOI: 10.1188/14.cjon.s3.59-67] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Nguyen PL, Alibhai SMH, Basaria S, D'Amico AV, Kantoff PW, Keating NL, Penson DF, Rosario DJ, Tombal B, Smith MR. Adverse effects of androgen deprivation therapy and strategies to mitigate them. Eur Urol 2014; 67:825-36. [PMID: 25097095 DOI: 10.1016/j.eururo.2014.07.010] [Citation(s) in RCA: 505] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 07/11/2014] [Indexed: 01/11/2023]
Abstract
CONTEXT Androgen-deprivation therapy (ADT) is a key component of treatment for aggressive and advanced prostate cancer, but it has also been associated with adverse effects on bone, metabolic, cardiovascular, sexual, and cognitive health as well as body composition. OBJECTIVE To review the current literature on the adverse effects of ADT and strategies for ameliorating harm from ADT. EVIDENCE ACQUISITION The Medline database (through PubMed) was searched from inception to August 1, 2013, for studies documenting the side effects of ADT and for randomized and prospective trials of interventions to mitigate those side effects. EVIDENCE SYNTHESIS Adverse effects of ADT include decreases in bone mineral density; metabolic changes such as weight gain, decreased muscle mass, and increased insulin resistance; decreased libido and sexual dysfunction; hot flashes; gynecomastia; reduced testicle size; anemia; and fatigue. Several observational studies suggest an increased risk of diabetes and cardiovascular events, although most published studies report that ADT is not linked to greater cardiovascular mortality. Randomized trials have found value in treatments for some adverse effects including bone loss (bisphosphonates, denosumab, selective estrogen receptor modulators), markers of metabolic syndrome (exercise, diet, metformin), gynecomastia (tamoxifen, prophylactic radiation), muscle loss (resistance and aerobic exercise), and hot flashes (venlafaxine, medroxyprogesterone, cyproterone acetate, gabapentin). CONCLUSIONS ADT is often a necessary component of the treatment of aggressive prostate cancer, yet it has known harms that can impair health and quality of life. Clinicians should be aware of interventions that can help mitigate these adverse effects. PATIENT SUMMARY Androgen deprivation therapy is a critical component of the management of aggressive and advanced prostate cancer, but it causes adverse effects including bone loss, metabolic changes, gynecomastia, muscle loss, hot flashes, and possibly increased cardiovascular events. Clinicians should be aware of interventions that can help mitigate these adverse effects.
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Affiliation(s)
- Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
| | | | - Shehzad Basaria
- Section on Men's Health, Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anthony V D'Amico
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Philip W Kantoff
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nancy L Keating
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, and Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - David F Penson
- Department of Urologic Surgery and the Center for Surgical Quality and Outcomes Research, Vanderbilt University, and the VA Tennessee Valley Geriatric Research, Education, and Clinical Center, Nashville, TN, USA
| | - Derek J Rosario
- Academic Urology Unit, Department of Oncology, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK
| | - Bertrand Tombal
- Division of Urology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Matthew R Smith
- Department of Hematology-Oncology, Massachusetts General Hospital Cancer Center, Boston, MA, USA
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Gartoulla P, Han MM. Red clover extract for alleviating hot flushes in postmenopausal women: a meta-analysis. Maturitas 2014; 79:58-64. [PMID: 25074017 DOI: 10.1016/j.maturitas.2014.06.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 06/25/2014] [Accepted: 06/26/2014] [Indexed: 01/14/2023]
Abstract
The safety and efficacy of red clover for alleviating menopausal hot flushes are yet to be established. The aim of this meta-analysis was to generate evidence from published literature regarding red clover as a treatment option for menopausal hot flushes. The results showed that red clover when compared to placebo was effective in reducing menopausal hot flushes when administered for 3-4 months (MD=-1.34, 95% CI=-1.90 to -0.77, p<0.00001), but their effect did not persist at 12 months (MD=0.89, 95% CI=-0.07 to 1.85, p=0.07).
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Affiliation(s)
- Pragya Gartoulla
- School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, VIC 3004, Australia.
| | - Myo Mint Han
- School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, VIC 3004, Australia
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Re: Alessandro Sciarra, Per Anders Abrahamsson, Maurizio Brausi, et al. Intermittent Androgen-deprivation Therapy in Prostate Cancer: A Critical Review Focused on Phase 3 Trials. Eur Urol 2013;64:722–30. Eur Urol 2014; 65:e56. [DOI: 10.1016/j.eururo.2013.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 12/11/2013] [Indexed: 11/18/2022]
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